Healthcare Provider Details

I. General information

NPI: 1245197912
Provider Name (Legal Business Name): MELINDA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 MCNUTT RD
SUNLAND PARK NM
88008-9621
US

IV. Provider business mailing address

812 ISABEL ST
ANTHONY TX
79821-7332
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-6101
  • Fax:
Mailing address:
  • Phone: 915-474-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number719551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: